Treating Alcohol Abuse and Dependence

The following treatment guidelines are meant as a reference tool, but are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

In general, treating alcohol use disorders follows the general principles of treating addictions, as described here. The various kinds of psychotherapy and counseling that are available are likely all equally effective [ref], and the choice of which ones to use are based on the individual's needs and preferences and on what is available at a given treatment center.

In addition to these treatment practices, there are various medications that can help for alcohol use disorders.

Medications for Alcohol Abuse and Dependence

Naltrexone is a medication that blocks the pleasurable effects of alcohol, and has been shown to be effective in helping individuals maintain abstinence after stopping alcohol use [ref]

In general, it has been found to be more effective when used in combination with psychotherapy, especially Cognitive Behavioral Therapy [ref]. However, for individuals with alcohol dependence who are not misusing any other substances and who do not have any concurrent psychiatric disorders (such as Depressive or Anxiety Disorders), treatment with Naltrexone alone, without any formal psychotherapy, and simply with follow-up in a primary care setting with regular appointments with a physician, nurse, physician assistant or clinical pharmacist, can be adequate [ref].

Combining Naltrexone with Gabapentin can improve the outcome of alcoholism treatment, especially during the first few weeks of treatment [ref].

Naltrexone is available in pill form and also in a long-acting injectible form that can be administered once a month. Because this medication is only useful if it is being taken on a regular basis, the monthly long-acting form can be helpful by avoiding the risk of doses being missed.

Gabapentin used alone can also help with recovery from alcoholism [ref]. At doses of about 1800mg daily it can help to reduce symptoms of insomnia, dysphoria (low moods) and cravings that often occur in individuals recoving from alcohol dependence, and which tend to lead to relapse of alcohol use.

Acamprosate is another medication that can help individuals who are recovering from alcohol dependence maintain abstinence [ref], though there have been some studies that have questioned its effectiveness [ref], and so it would be considered a second choice after Naltrexone. There does not seem to be much benefit in combining Acamprosate and Naltrexone [ref].

Disulfiram is a medication that blocks the normal metabolism of alcohol and causes people to feel very sick after drinking, and is thus used as a way to discourage individuals from continuing to drink. However, it is not a first choice recommendation for treatment because the evidence for its effectiveness is not strong [ref], and because it only works if individuals make sure to take it regularly. It can also cause very severe and potentially life-threatening reactions when alcohol is consumed. Its use should be reserved mainly for individuals in stable social situations who are not impulsive, who are highly motivated to remain abstinent, and who are receiving psychotherapy and/or counseling [ref]